title: Fewer interventions in the immediate post-extubation management of pediatric intensive care unit patients: safety and cost containment.
abstract: OBJECTIVE
  The purpose of this article was to compare the safety and patient charges of two postextubation treatment regimens.
  
  
  METHODS
  Twenty-two pediatric patients, between the ages of 7 months and 13 years, who were mechanically ventilated for less than 5 days were studied in a prospective randomized nonblinded study at a multidisciplinary pediatric intensive care unit. Immediately after extubation all patients received supplemental oxygen, administered via mask or nasal cannulae, at a flow rate or concentration sufficient to maintain the pulse oximetric arterial oxygen saturations > 95%; arterial blood gas analyses were performed at 30 minutes after extubation. The subjects were randomly assigned to one of two protocols. Protocol A (our standard management) consisted of (1) three nebulized albuterol treatments administered 1 hour apart, and (2) a chest radiograph obtained within 60 minutes of extubation. Protocol B included one nebulized albuterol treatment administered immediately after extubation. We measured the heart rate, respiratory rate, and arterial blood pressure immediately after and at 60, 120, and 180 minutes following extubation. The following data were also recorded: arterial blood gas analysis results and continuous pulse oximetric arterial oxygen saturation levels. Any significant complications, such as stridor, respiratory distress, or requirement for reintubation, were noted if they occurred within 24 hours of extubation. Patient charge costs were calculated after obtaining the prevailing hospital and physician charges at the time of the study.
  
  
  RESULTS
  Eleven patients completed each arm of the study (total = 22). There were no statistically significant differences between the two groups with respect to arterial pH, serum bicarbonate, pulse oximetric arterial oxygen saturation, arterial blood pressure, respiratory rate, or heart rate (P > .05). Patients treated with Protocol A had a statistically, but not clinically, significant higher mean PaO2 and PaCO2 (P = .02 and P = .05, respectively) than those in Protocol B. Associated charges per patient for Protocol A were $863.50 versus $476.00 for Protocol B. This is a savings of $387.50 per patient. Our pediatric intensive care unit provides care to over 600 intubated patients per year, which would equate to a charge savings of $232,500.00 per year.
  
  
  CONCLUSIONS
  A modified postextubation management protocol, consisting of fewer interventions, resulted in significant patient charge savings with no increased risk to the patient.
authors.affiliation: Division of Critical Care Medicine, Miami Children's Hospital, FL 33155, USA.
authors.forename: M
authors.initials: M
authors.lastname: Soler
authors.forename: A
authors.initials: A
authors.lastname: Raszynski
authors.forename: R J
authors.initials: RJ
authors.lastname: Kandrotas
authors.forename: J B
authors.initials: JB
authors.lastname: Sussmane
authors.forename: R
authors.initials: R
authors.lastname: Aznavorian
authors.forename: J
authors.initials: J
authors.lastname: Wolfsdorf
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000420:Albuterol / Q000008:administration & dosage / Q000191:economics; D001794:Blood Pressure; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000191:economics; D002648:Child; D002675:Child, Preschool; D003363:Cost Control; D003422:Critical Care / Q000191:economics* / Q000379:methods*; D005251:Fees, Medical; D005260:Female; D006339:Heart Rate; D017722:Hospital Charges; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000191:economics; D007442:Intubation, Intratracheal / Q000191:economics; D008297:Male; D010100:Oxygen / Q000097:blood; D011182:Postoperative Care / Q000191:economics* / Q000379:methods*; D011446:Prospective Studies; D012119:Respiration; D012120:Respiration Disorders / Q000503:physiopathology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D000420:Albuterol; D010100:Oxygen